| Purpose In this systematic review, we analyzed the optimal time range to evacuate traumatic-retained hemothorax using
video-assisted thoracoscopic surgery (VATS).
Methods We searched PubMed, EMBASE, the Cochrane Register of Controlled Trials, Google Scholar, and the U.S. National
Library of Medicine clinical trials database up to February 2019. Randomized controlled trials (RCTs) and observational
studies with relevant data were included. Data were extracted from studies that reported the success, mortality, or length
of hospital stay (LOS) after using VATS during at least two out of three of our time-ranges of interest: days 1–3 (group A),
days 4–6 (group B), and day 7 or later (group C).
Results Six cohort studies with 476 total participants were included in the meta-analysis. The patients in group A had a
signifcantly higher success rate than those in group C (RR=0.42; 95% CI=0.21–0.84, p=0.01). The total LOS for patients
whose retained hemothorax was evacuated in group A was 4.7 days shorter than that for those in group B (95% CI= −5.6
to −3.8, p=0.006). Likewise, group B patients were discharged 18.1 days earlier than group C patients (95% CI= −22.3
to −14, p<0.001). Short-term mortality was not decreased by early VATS.
Conclusions Our results indicate that VATS should be considered within the frst three days of admission if this intervention
is the clinician’s choice to evacuate a traumatic-retained hemothorax. |